Tuesday, July 03, 2007

A couple of items to share with you on the issue of TBI. The first is a very informative and well-written piece appearing in the July 2, 2007, issue of The American Conservative magazine. "Hidden Wounds," written by Kelley Beaucar Vlahos (who also authored a solid 2006 FOX News piece on PTSD in which she was kind enough to quote me in as well), is well worth taking the time to read.

Click on 'Article Link' below tags for more...

An opening graf:

If TBI is the silent affliction of this war, the casualty count should be the canary in the coal mine. As of mid-May, the military in Iraq suffered 14,804 injuries that required medical transport off the battlefield. This included 7,628 combat wounded and 7,176 non-hostile injuries, plus 19,589 “diseases,” which cover everything from a bacterial infection and mental disorder to cancer and pregnancy, that also required medical air transport. In Afghanistan, 6,213 injured soldiers were evacuated from the field, including 743 combat-related, 1,458 non-hostile, and 4,012 diseases.

Symptoms of TBI can turn up in any of the these categories. According to various reports, of the 1.4 million who have rotated through Iraq and Afghanistan, anywhere from 10 to 30 percent have been exposed to a bomb blast or other head trauma, leaving them with at least mild TBI. A recent study by doctors at Fort Carlson Army base in Colorado found that 18 percent of their returning soldiers had incurred a brain injury in Iraq.

A bit more of the American Conservative article (including a quote of mine that made the cut), along with news of Illinois Governor Rod Blagojevich's new program aimed at testing his state's National Guard troops for war's most invisible of wounds. Illinois veterans returning with TBI and/or PTSD will get the care and resources they need to ease their transition home.

Article quoted from extensively for educational purposes.First back to the American Conservative:

Some 60 percent of the veterans in the VA’s Polytrauma Rehabilitation Center in Tampa, Florida, one of 21 centers handling vets with severe, multiple injuries, have a brain injury, according to ABC newsman Bob Woodruff in a February series he put together after his own year-long recovery from an IED blast. Meanwhile, officials at the Defense and Veterans Brain Injury Center, the military’s primary research and treatment facility for TBI, has treated 2,130 patients since 2003.

“That’s just a small percentage of the total number, and the fact is, nobody really knows how many have mild [TBI],” said Col. Jonathan Jaffin, Commander of U.S Army Medical Research and Materiel Command at Fort Detrick, Maryland and a spokesman for the DVBIC. He said 70 percent of their cases are mild and those affected may, with the right treatment, recover or at least adjust to their disabilities. But it is not clear, according to doctors, how soldiers with cumulative concussive injuries will fare long-term. All seem to agree the body of research on non-fatal blast injuries is thin.

One more bit:

“Mild head injury for years had been somewhat neglected,” Jaffin says, with standard testing for TBI often missing less severe cases. “So people would be suffering and being told they are normal.” As the pervasiveness of TBI among returning service members became clear, he said, the military and VA began developing better ways to detect it—though advocates will dispute their commitment.

VA officials say they are treating nearly 400 veterans diagnosed with moderate to severe TBI, while overall they have seen more than 1,600 potential cases since 2002. They acknowledge, however, that the system has yet to compile statistics for mild cases or outpatients.

Meanwhile, symptoms of mild to moderate TBI go unchecked, crowded out by the more obvious injuries. Furthermore, misdiagnosing TBI—most likely mistaken for PTSD—is commonplace.“When it does occur, PTSD and TBI together can be especially difficult to spot. The problem lies in the overlapping symptoms—increased anxiety, short attention span, limited concentration, problems with memory. This overlap muddles things up,” points out Ilona Meagher, author of Moving a Nation to Care: Post-Traumatic Stress Disorder and America’s Returning Troops. “Once you have these kinds of errors on military records,” she added, “it creates a whole other level of problems down the road for the veteran after they’ve returned home.”

That road is paved with the stories of men and women who find that the system is no more compassionate than it was for their counterparts returning from Vietnam a generation ago. The PTSD label is not only stigmatizing, but its symptoms are often mistaken for personality disorders and are blamed for behavioral problems like insubordination and substance abuse, resulting in a one-way ticket out of the military with no retirement pay or benefits.

“This time it’s all about money—they just don’t want to pay,” insists Sullivan. But unlike previous wars, there is a small army of veterans’ advocates, many who cut their teeth on behalf of Persian Gulf soldiers in the 1990s.

Steve Robinson, also with Veterans for America, packed his experience and reputation along with his bags and spent most of May around Fort Carson, pulling together a massive case accusing the command of erroneously discharging 276 soldiers for personality disorders. These servicemembers all suffered from PTSD, and many had accompanying TBI diagnoses. His organization is also investigating more than 40 current cases on the base. They include bad discharges but also complaints from soldiers that their brain injuries and mental-health problems were mishandled or ignored by superiors.

Gov. Blagojevich announces landmark Traumatic Brain Injury and Post Traumatic Stress Disorder program for Illinois Veterans First in the nation program to provide TBI screening for state’s returning Iraq and Afghanistan Veterans, mandatory screening for returning Guard members and 24-hour PTSD helpline

CHICAGO – On the eve of Independence Day, Governor Rod R. Blagojevich was joined by Tammy Duckworth, Director of the Illinois Department of Veterans’ Affairs (IDVA) to announce a first-of-its-kind program to screen every returning Illinois National Guard member for traumatic brain injury (TBI), offer TBI screening to Illinois Veterans, and 24-hour toll-free psychological assistance for Veterans suffering from PTSD. The program increases health care benefits for Veterans and will later become part of the Governor’s Illinois Covered insurance plan.

The program will work in two parts: The TBI portion will mandate screening for all Illinois National Guard members returning from deployment and offer free screening to all Illinois Veterans, especially those returning from Operation Enduring Freedom and Operation Iraqi Freedom. The PTSD portion will offer 24-hour, toll-free psychological assistance to give Veterans suffering from PTSD a place to turn, day or night, for help.

“As the wars in Iraq and Afghanistan continue, we’re seeing what a serious toll combat can take on the mental health of the brave men and women fighting on our behalf. Every day our troops are encountering danger, violence and tragedy that most of us can’t even imagine. After they’ve given so much to protect our freedom, we should do everything we can to help them live productive and stable lives when they return home. We can’t wait for the federal government to catch up with the new and growing mental health needs associated with combat, or for Illinois lawmakers to approve the comprehensive Illinois Covered program. Too many returning soldiers and Veterans need help now,” said Gov. Blagojevich.

The announcement makes Illinois the first state in the nation to establish a statewide TBI program offering screenings for all Veterans and mandatory screening for Illinois Army National Guard members. The new PTSD and TBI program will later become part of the Governor’s Illinois Covered plan to provide access to affordable health coverage for every Illinoisan.

“As this war continues, and more of our troops are being deployed multiple times into combat, the number of Veterans suffering from TBI and battling PTSD will only grow as these brave men and women return home,” said Tammy Duckworth, IDVA Director. “The time is now to help our heroes who have fought for our freedoms, who have sacrificed their lives for us. We must, at the very least, make sure they all have access to the health and psychological care they deserve. I am proud to see Illinois set an example of how to care for and treat those who have served this country by establishing this PTSD and TBI program.”

On June 15th, the Pentagon Task Force on Mental Health released a report declaring that the military "falls significantly short" in providing adequate psychological care to service members. The report stated that mental illness has become a major issue because of the system’s lack of fiscal resources and trained personnel, the prejudices towards mental illness, and the long exposure to combat in Afghanistan and Iraq. The report found that there is a stigma attached to mental health problems among service members that interferes with access to care, quality of care and continuity of care. The report also stated that service members who were deployed multiple times were more likely to screen positive for a mental health issue.

The use of improvised explosive devices (IEDs) in Iraq has led to a sudden rise in traumatic brain injuries. The Illinois Department of Veterans’ Affairs (IDVA) and the Illinois Department of Healthcare and Family Services (HFS) will be working with the Rehabilitation Institute of Chicago (RIC) to implement the screening tool for TBI. The tool was created by Dr. Elliot Roth, Senior Vice President, Medical Director, and Felise Zollman, Medical Director of the Brain Injury Program at RIC. The screening will take approximately 20-30 minutes. The program will offer mandatory screenings for Illinois Army National Guard and the option for all returning Illinois Veterans, especially those returning from Operation Enduring Freedom and Operation Iraqi Freedom.

“Traumatic brain injury is one of the most complicated injuries to treat. The brain is the human body’s most complex organ, its injuries can manifest in ways that are not readily apparent and the process of detecting and determining the extent of injury can be highly complex,” said Dr. Felise Zollman, Medical Director for the Rehabilitation Institute of Chicago’s Brain Injury Medicine and Rehabilitation Program. “RIC stands ready and eager to serve our nation's injured service men and women by lending our expertise and providing the best clinical care in rehabilitation that our country has to offer.”

Because TBI shares many of the same symptoms as PTSD, healthcare professionals often misdiagnose mild traumatic brain injuries for PTSD, especially when visible wounds are lacking. This misdiagnosis becomes problematic because TBI and PTSD are treated differently. The screening will assist clinicians in diagnosing the service member and refer them for further TBI screening if needed.

According to numbers reported by the Associated Press on June 23, 2007, “only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries.”

On the federal level, earlier this year Senator Dick Durbin (D-IL) authored legislation in the Senate to require the Departments of Defense (DOD) and Veteran Affairs (VA) to implement a comprehensive program to diagnose, treat and rehabilitate service members and Veterans who have suffered a service-related traumatic brain injury.

“TBI and PTSD are signature wounds of this war,” Senator Durbin said. “We need to improve care at the federal level so Veterans across this country have all the resources they deserve. I applaud Governor Blagojevich and Director Duckworth for stepping in and taking action on behalf of Illinois Veterans.”

The PTSD portion of the program will include a 24-hour, toll-free psychological assistance service to all Illinois Veterans. The toll-free number will ring into a call center staffed by trained clinicians or nurses with at least one trained Psychiatrist at the center and on call at all times. The psychiatrists and staff will be trained in the area of combat-related PTSD and other psychological issues facing Veterans. When a Veteran calls the hotline, a clinician will perform an initial over-the-phone screening and determination for the next steps.

The PTSD program will help Illinois Veterans in many ways, they include:

Offering 24 hour toll-free assistance that will be available for Veterans to call at the very time they need support, day or night. Assisting with the resistance to seek help due to the stigma that is often associated with PTSD. The 24 hour toll-free number enables Veterans to simply pick up the phone at anytime and receive immediate care without having to wait the days and weeks that they would typically experience when trying to access care through the Federal VA system.

Traveling long distances often deters many Veterans suffering from PTSD who are not able to go the distance to obtain the necessary help. The Governor’s PTSD program allows all Veterans to access help regardless of their proximity to a VA facility.

Kudos to the governor of Illinois and other communities being proactive in reaching out to their population of returning troops.

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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

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"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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